Injury
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To assess the effect of alcohol intoxication on injury severity and head injury assessment, blood alcohol concentrations (BAC) were related to the severity of injuries (Injury Severity Score and Assault Trauma Score) and Glasgow Coma Scores (GCS) in 242 consecutive victims of weekend, night-time assault, none of whom had head injuries. No correlation was found between degree of intoxication and severity of injury. ⋯ The median BAC in patients with a normal GCS was 115 mg/100 ml. Neurological assessments need to take account of the highly variable, depressive effects of alcohol.
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We critically evaluated several diagnostic modalities (clinical criteria, subxiphoid pericardial window (SPW) and laparoscopy) used in the detection of occult cardiac injury in haemodynamically stable patients at high risk of cardiac injury. Over 5 years, 122 patients were admitted to a Level I trauma centre with such an injury. They sustained 69 stab wounds, and 53 gunshot wounds. ⋯ SPW remains the standard means of diagnosing occult cardiac injury in high-risk patients. Since the incidence of occult cardiac injury in haemodynamically stable patients is 20 per cent, SPW should be used liberally. Laparoscopy may have a role in evaluating the pericardium in the subgroup of patients with lower chest wounds, and it facilitates inspection of intra-abdominal viscera and diaphragm at the same time.